"Diabetic foot" living Governance

Bo-year 72-year-old history of hypertension more than 20 years, a year ago, also found diabetes. The past six months, when there is calf muscle cramps at night, walk over time, there will be leg pain, claudication, rest a while to be improved. Winter because of cold-blooded, with hot-water bottle Wu feet, causing burns, although the dressing was changed several times, but it has not improved, the wound festering, surrounded by swelling, prolonged unhealed. "Diabetic Foot" is a common complication of diabetes.

Although diabetes is only found in Bo-year, as it has long been suffering from diabetes, and it has not yet discovered. The prevalence of diabetes increases with age, such as the Bo-old elderly, diabetes is quite prevalent in. According to the survey, China's urban diabetes prevalence rate of 1%, after 40 years of age increased linearly with age, and almost every increase of 10-year-old, the sick rate increased by 1%. These elderly people often do not have the typical diabetic polyuria, polydipsia, food, wasting so-called "little more than three a" phenomenon, but with body fat much more prevalent. This is because obese people often have defects in insulin receptor can cause a relative shortage of insulin. Diabetes is often associated with high blood pressure. According to statistics, in the diabetic patients, 40% to 80% with hypertension, for the general population of 4 ~ 5 times. The long-term diabetes can cause big arteriosclerosis, coronary heart disease cerebral arteriosclerosis. Diabetes can also be caused by microvascular disease affecting the kidneys, there diabetic nephropathy, this is another factor in the formation of high blood pressure. Hypertension exacerbated diabetic nephropathy, so that kidney damage is increasing. Diabetes can also affect the nervous system, there diabetic neuropathy, usually manifested peripheral neuropathy, there limb paresthesia, decreased. As the limb hypoesthesia, easily damage occurred, and because the nerve and blood vessel disease, lower extremity skin and nutritional bad, once the damage difficult to heal, easy to secondary infection and the formation of ulcers and permanently. Because peripheral neuropathy can lead to a small foot muscle atrophy, showing claw-shaped toe. Because the foot deformation, gait changes, the focus can change, easy to produce calluses, corns, friction prone to injury. Coupled with limb autonomic neuropathy, sweating to reduce foot dry skin, limb ischemia caused by atherosclerosis, is extremely vulnerable skin ulcers, infections. As the limb atherosclerosis, lower limb ischemia, can cause calf cramps easy to walk a long time when the lower limb pain, limp, have a rest before mitigation, this phenomenon is medically known as "intermittent claudication." Above neuropathy, vascular disease and infection constitute the three major factors that diabetic foot.

"Diabetic Foot" focus on prevention and treatment of personal protection, it is necessary to avoid foot injury, to prevent secondary infection. Diabetic people should quit smoking, because smoking can aggravate atherosclerosis. Diabetics should pay attention to footwear suitable, not too tight, perfect day, and whether the foreign body should check the shoes, nail cuttings, etc. insole is flat. Shoes should fit to wear new shoes for each not more than two hours, but not to walk long distances in order to avoid foot wear. Do not wear herringbone slippers; night to check whether the foot and toes blisters, scratches or skin lesions, if necessary, use a mirror view the foot and, if necessary to timely diagnosis and treatment. Their feet with warm water every night, every 10 to 15 minutes, in order to promote blood circulation and lower limbs. Feet or hand or elbow before measuring about water temperature, so as to avoid occurrence of foot burns sensory dysfunction. Bubble over, use a soft dry towel Kaigan, in particular the gap between the toes should gently Kaigan. Winter should pay attention enough to keep warm, shoes to keep dry, insole and often Xishai, suitably soft and warm insole, Yichuan wool socks or cotton socks to help keep warm moisture. Cool enough to ease the night to wear socks, but do not use hot-water bottle, soup Pozi, small stoves warm feet, in order to avoid scalding. The skin too dry, can be partially coated lanolin or urea cream to prevent skin cracking. To timely treatment of tinea pedis, to corns, calluses should be treated early, do not use corrosive ointment, such as corns. If foot pain, to seek early treatment, not to abuse tape affixed feet. Do not walk barefoot at any time (even on the beach), to avoid foot injuries. If visual impairment should be relatives or friends to help trim toenails, calluses, do not themselves operate so as to avoid damage. Do not cut nails too short, angle should be blunt and smooth so as to avoid stabbing. Do not cross legs, a long time in order to avoid oppression of blood vessels, nerves. In addition, the treatment of diabetes should actively strive to control the blood sugar at normal levels. The event of foot ulcers, wounds, to early treatment. Aspirin, dipyridamole and so on can reduce the platelet aggregation, relieve blood hypercoagulability, and clear the microcirculation. Chinese medicine has a similar role in promoting blood circulation. To take active conservative treatment will enable 70% of the "diabetic foot" freedom from amputation.

With the average life expectancy of people with diabetes, "Diabetic Foot" prevalence rate of increase, prevention and treatment of diabetic foot, the key is to draw attention to careful self-care, a preventive measure.

"Five carriages" reveal the mystery of diabetes mellitus

Diabetes, Chinese medicine called Diabetes disease. Back in BC, the Chinese medicine literature, on the urine of patients with documented Diabetes is sweet, and have thirst, polydipsia, polyuria, polyphagia and other clinical characteristics, patients are frequently post-fatigue, weight loss, therefore called "Diabetes "and raised over nutrition and obesity and diabetes are closely related. However, the ancient understanding of the nature of the disease still has not a small gap, and this situation only until the 19th century, significant progress, in 1869 a German doctor found in the pancreas of human existence "islet" and can secrete insulin, the diabetes Modern research started. The other two German doctors in 1889, further evidence of the relationship between the pancreas and diabetes, doctors in Canada in 1921, Banting, who succeeded the first time, extracted from animal pancreas, insulin, thus many young lives have been saved with diabetes. Doctors Banting received the Nobel Prize, and his birthday - November 14 by the United Nations as World Diabetes Day.

The cause of diabetes is still not very clear, only to find that a number of diabetes-related factors. It is generally believed that diabetes is genetic factors and environmental factors (including excess calorie intake, lack of activity, obesity, mental stress too much, etc.) working together, due to a lack of insulin secretion and (or) insulin resistance caused by sugar , protein and lipid metabolic disorder a chronic, lifelong disease. Diabetes is usually divided into type 1 diabetes, type 2 diabetes, gestational diabetes and other special types of diabetes.

Type 1 diabetes is mainly due to immune factors have led to serious destruction of islet �-cell, so that absolute lack of insulin secretion; 2 diabetes is mainly relatively inadequate insulin secretion, reducing the body's insulin sensitivity (ie insulin resistance)-induced. The typical symptoms of diabetes as "more than three a little", that is, polydipsia, polyuria, polyphagia and weight loss, and fatigue associated with weakness. If the condition is not well controlled, the further development of the body caused by a variety of serious acute and chronic complications. There are acute complications of diabetic ketoacidosis, non-ketotic hyperosmolar coma, lactic acidosis and so on. With the extension of duration, metabolic disorders can also cause eye, kidney, nerves, blood vessels and heart and other organs of chronic damage, and eventually took place blind, uremia, lower limb gangrene, neuropathy, severe infection, stroke or myocardial infarction a serious threat to health, these complications are caused by patients with chronic disability, major cause of death.

Although scientists and doctors have always been committed to diabetes research, but has yet to find a method to tackle diabetes. Got diabetes, it means to be accompanied with life. For the diabetes treatment goals is to make the disease a long period of ideal or good control. Diabetes treatment is comprehensive, is a systematic project, the current clinical treatment of diabetes there are five recognized methods, known as "five carriages" - diabetes education, diet therapy, exercise therapy, drug therapy and disease monitoring.

Diabetes education refers to study in patients with diabetes prevention knowledge, only mastered the relevant knowledge, they can better meet the doctor for treatment, in order to become a master of controlling diabetes. Diet therapy and exercise therapy is the basis for the treatment of diabetes, on this basis, a reasonable use of drug therapy can effectively control blood glucose and a series of indicators. At the same time should also attach importance to disease surveillance, in particular, blood glucose self-monitoring, periodic inspection of the indicators, understand the disease and guide treatment.

Long-term practice that the "five horse-drawn vehicles" is the magic weapon against diabetes, the five, only five horses and riding Qi trend in order to achieve full control of diabetes, and ultimately achieving longevity and enjoy the good life goals.

Guard against diabetes, "corrosion" of your hand and foot

Hands and feet suddenly appear to ulceration, pus, Liu aunt thought it was skin, everywhere a doctor, spent a few thousand dollars, but he is not seen well. Surprisingly, in a physical examination, doctors found the original hand-long treatment of the rotten rotten feet are the fault of diabetes. Who lives in mountainous Liberty Street, Liu Li-aunt, 72 years old. Last year, in February, Liu aunt found their hands and feet began to blister, Diaopi. At first, she thought it was hand, foot and ringworm, it at home on a number of drugs. Spent half a month, not only has not brought the matter to the symptoms, but more and more serious, hands and feet of the skin begins to fester, pus. Madame Liu dermatologist doctor rushed to the hospital, the doctor failed to give specific reasons, but opened a lot of her medicine. Liu aunt said that in order to see the disease, she ran several hospitals in dermatology, light money to buy medicine doctor spent several thousand dollars. However, rule-day more than six months, patients are not seen and finally even walking are subject to a lot of influence down the stairs by the arm had to his family.

Last year, in September, Liu aunt because the stomach for a few days hospital doing regular blood sugar checks, doctors found that the old lady of the fasting blood glucose has reached 11.8, it will be defined as diabetes, so she was quickly hospitalized. Finally, through the Department of Endocrinology, doctor, Liu aunt belongs to type Ⅱ diabetes mellitus, and should have been a very long time, just some of the symptoms of diabetes, by her neglected, while the hands of Madame Liu is also a part of ulceration as a complication of diabetes. Now, after several months of the treatment of diabetes, Liu aunt's blood sugar has been controlled, hands and feet ulceration of the symptoms improve anytime soon.

Anshan Central Hospital ward Li-Yan Han, director of stem attending a briefing, Liu aunt this case belongs to diabetic foot, also known as diabetic gangrene, is a common complication of diabetes. The main cause is due to peripheral neuropathy? Points, including autonomic neuropathy? Snow, big foot vascular disease and poor health habits, and many other factors, the result of complex interactions between, and in severe lower limb may occur ulcers, gangrene, need to amputation treatment. Therefore, there Mrs aunt of such symptoms should go to hospital for examination, so as not to delay the best time for treatment.

Treatment diabetic Foot hyperbaric oxygen have unique skill

Hyperbaric oxygen therapy principles are not complicated, it is the use of higher than the atmospheric pressure of 2.5 ~ 3 times the high-pressure chamber, inhaled 100% oxygen, the concentration and pressure have increased in the case, not only red blood cell oxygen content increased, also allow oxygen dissolved into the plasma inside, so that oxygen diffusion into hypoxic organizations (such as diabetic wounds, osteomyelitis, severe infection of the wound, etc.), oxygen enrichment can stimulate the formation of collagen fibers, promoting angiogenesis, but also enhance the white blood cell phagocytosis, inhibit bacterial toxins, and thus control infection, promote wound healing. After just 50 years old, Liu mother's sister is 10 years of diabetes patients. As the regular out-patient medication, blood glucose control and stability, life has not been affected. But inadvertently came up with a small toe wound, a full two months she was hospitalized, and even lost nearly crippled the entire left palm, Liu mother's sister was a real understanding of diabetes, the body of the potential extent of harm, but also personally Experience of hyperbaric oxygen on the benefits of treating diabetic wounds.

In fact, Liu Aunt than the exception. Because every four people with diabetes have a doctor because of foot problems, 15% of patients had foot ulcers occur in life. More alarming is that 45% ~ 70% of amputations occurred in the misfortune of patients with diabetic foot ulcers. Once faced with amputation, not only an increase in medical expenditures, and the patient's physical, mental, family and even the economy will be affected.

Lightly: loss of a small toe

Most people foot bumps, at most 35 days to heal without problems, why the feet of diabetic patients are particularly vulnerable to injuries but no better?

Neuropathy and vascular disease is a common complication of diabetes. Reduced autonomic neuropathy makes the sweat and cause the skin dry and chapped easily, sensory nerve lesions give the feeling of pain in patients with slow change. Vascular lesions leading to the size of blood vessels are easily blocked, cyclic variation, the skin prone to "malnutrition."

Sensory change slow and easy to dry and chapped skin, bumps or a tear a little careless, it is easy to bacterial infection, coupled with poor blood circulation, tissue hypoxia, leukocytes can not completely kill the invading bacteria, antibiotics can not be through blood cycle time to kill bacteria, so bacteria can spread quickly, cause a large number of muscle tissue necrosis fester and become diabetic foot ulcers.

Aunt Liu is such a small wound all the way developed into major problems. She likes to wear sandals, one day found that his left little toe broken a small hole in, did not mind a delay of a week the wound is getting bigger, the muscles around the toes black, with blood leaking from inside. Liu aunt with her daughter rushed to large hospital for treatment, doctors removed her little toe. Liu aunt sad kept alive that she worried about is that the wound or the dark damp.

Hyperbaric oxygen joining "treatment Corps"

Liu Aunt accepted treatment is multi-faceted, and can be described as a "treatment Corps", including controlling blood pressure, blood sugar, blood lipids, hypercoagulable state as well as infections, large blood vessels, capillaries and nerve disease treatment. Later, the doctor suggested Aunt Liu comprehensive treatment of the above-mentioned basis, with hyperbaric oxygen therapy in order to promote wound healing. After a detailed explanation of some doctors, Liu Aunt understand this truth, so in the second debridement surgery (excision and cleaning the wound of necrotic tissue) before and after, received hyperbaric oxygen therapy.

After more than ten times of hyperbaric oxygen therapy (two courses), and comprehensive treatment, the wounds of Aunt Liu obvious improvement has been healing rapidly changing and new flesh, finally can be discharged to go home. She also learned to always view whether unusual or foot wounds, dry skin, rubbing lotion on the need lubrication, select the soft leather fit the Baoxie, wearing cotton, thick soft, loose socks to protect feet.

For diabetic foot wounds in patients with the problem, the traditional treatment is to give antibiotics to control infection, local debridement and dressing, if it continues to deteriorate only take the amputation of a passer-by, which patients and their families are a heavy blow. Diabetic foot lesions had the medical, economic and social ones. Hyperbaric oxygen by adding "treatment Corps", even if still amputation, but also have the opportunity to not remove too much range.

Promoting wound healing: the mechanism is simple

Hyperbaric oxygen therapy principles are not complicated, it is the use of higher than the atmospheric pressure of 2.5 ~ 3 times the high-pressure chamber, inhaled 100% oxygen, the concentration and pressure have increased in the case, not only red blood cell oxygen content increased, also allow oxygen dissolved into the plasma inside, so that oxygen diffusion into hypoxic organizations (such as diabetic wounds, osteomyelitis, severe infection of the wound, etc.), oxygen enrichment can stimulate the formation of collagen fibers, promoting angiogenesis, but also enhance the white blood cell phagocytosis, inhibit bacterial toxins, and thus control infection, promote wound healing.

In general, hyperbaric oxygen therapy in wound healing and immune regulation have a role in such areas to help improve microcirculation, thus preventing and treating diabetic complications, while hyperbaric oxygen therapy reduces the organization because of congestion caused by ischemia and hypoxia edema, high blood sugar due to the long-term damage caused by tissue hypoxia and peripheral neuropathy have therapeutic effects. In addition, hyperbaric oxygen therapy can inhibit the growth of anaerobic and aerobic bacteria breeding, to enhance leukocyte phagocytosis and bactericidal ability to enhance the sterilization of certain antimicrobial agents or antimicrobial effect, thereby to control wound infection. Should be pointed out that, although the high-pressure oxygen therapy is widely used in clinical subjects, there are certain contraindications. In view of this, whether hyperbaric oxygen therapy, treatment pressure, time, treatment is required under the guidance of a doctor.

Treatment of diabetic foot ulcers cure for special efficacy medicine

According to the British "Daily Post" recently reported that the U.S. state of Oregon physicians Cheryl clinical trials found that, compared with the iodine and some antibiotics, these drugs more effectively in water diabetic foot cure ulcers, treatment to be reduced from more than 50 days to 43 days. California researchers have recently developed a new type of topical medicines can effectively treat diabetes-induced foot ulcers.

Foot ulcers are one of the complications of diabetes, which may lead to infection in severe cases may result in amputation. According to British "Daily Post" recently reported that the U.S. state of Oregon physicians Cheryl found through clinical trials, as compared with the iodine and some antibiotics, these drugs more effectively to cure diabetes water in patients with foot ulcers, treatment to be reduced from more than 50 days to 43 days. Andrew Bolton, the United Kingdom, said the researchers, from the preliminary test results, the new ideal of syrup efficacy.

The role of this principle of medicine is that it contains elements able to "recognize" a variety of organizations, bacteria invade the feet, and through the cell wall of these organisms to "holes" will kill them quickly, but the body's normal cells do not be subject to new drug molecule attacks.

Reported that the medicine can kill Clostridium bacteria, E. coli, salmonella, tuberculosis and so on. Because sterilization faster, damaged foot cells can be quickly repaired, thereby promoting greater blood flow to the ulcer site, so that the wounds can heal faster.

Necrosis of the focus of diabetic foot care

According to national data show that diabetic patients with foot necrosis occurred 17 times the non-diabetic patients, accounting for 66% of patients with

amputation, diabetes is a serious threat to the health of one of the serious complications. The treatment of diabetic foot necrosis alone is not enough to

improve the care that will make the treatment reaches the multiplier effect. Care for diabetic foot necrosis focus in the following areas.

Local treatment: First, pus should be collected and sent to bacterial culture and sensitivity test in order to select sensitive to antibiotics. For the foot

of necrotic tissue should be phased-graded removed and the incision wound drainage in order to maintain smooth. Infected wounds have to use 0.1%

chlorhexidine and 3% hydrogen peroxide scrub, daily dressing 1 for non-infectious small trauma is no exception. Topical application of 654-2

microcirculation. Peacetime should Taigaohuanzhi to facilitate blood return.

Keep feet clean: Diabetic foot acral necrosis occurs in patients with pain, temperature perception barriers, is appropriate to warm their feet every night

before bed (non-affected side), water temperature should not be high, every 10-15 minutes, after washing to toe clearance at soft dry. 1 times per week

should be nails to prevent scratching the skin infection.

Diet Care: According to the patient's ideal body weight to calculate the daily total calories, diabetic foot infection in patients with necrosis of a large

consumption and heat should be properly increased 10% -20%, while according to patients with eating habits, so that diverse recipes. To regularly

quantitative meal insulin injections are even more so.

Psychological Care: Diabetic patients with foot gangrene accompanied by stench, often inferiority In addition, some people were hospitalized longer, easy to

produce anxiety. Their families and doctors should be more comfort, encourage, timely dispersal, in which patients state of mind and stability, with the

treatment.

Anti-diabetic foot often touch instep

Diabetic foot are a common complication of diabetes, but people tend to diet and drug therapy during a time when blood sugar at the expense of maintenance

and care of the foot, so that it will happen ulcers, gangrene, a serious need for amputations. Lower extremity diabetic patients responded very "obtuse," I

do not know hot and cold, there is no pain, is not easy to early detection of lesions, although angiography, magnetic resonance, ultrasound and so can detect

signs of disease, but these checks do have to spend a lot of "silver", there examination of both economical and convenient way to do that?

Third People's Hospital of Zhengzhou City, deputy director of Department of Endocrinology, Dr. Liu Long gave birth to a trick taught to patients, the

dorsalis pedis artery dorsal foot touch and feel whether the abnormal pulse. This is the Endocrine Section, Department of Neurology, etc. Through the past

few years in patients with type 2 diabetes screening through palpation summed up.

Dorsalis pedis artery in a good position to find, included, to connect the dorsal lateral malleolus, between the two tendons, the patient can use both hands

to exert the same pressure on the index finger, not too much vigor to find pulse after they look at the strength of feeling If the pulse significantly

decreased or disappeared, foot lesions more likely to occur, it is necessary and timely to the hospital in order to detect lesions.

From a clinical perspective, diabetes five to ten years, it started to occur in the foot lesions, so the "age of five," patients often use this method is

best to detect, early detection of abnormal dorsalis pedis artery.

Note that the lower extremity arterial disease atherosclerosis is the systemic performance, dorsalis pedis artery abnormalities in patients with diabetes,

very easy to merge cardio-cerebral vascular diseases.

Therefore, there dorsalis pedis artery abnormalities in patients can be under the guidance of a doctor taking lipid-lowering drugs, such as statins, and

vasodilators, such as Salvia and so on.

The doctor's advice: exercise can reduce insulin resistance, lower blood sugar, diabetic lower extremity lesions appeared on how people should choose

activities?

Open diabetic foot lesions, such as ulcers, infections, gangrene, is not suitable for sports, and weight-bearing foot lesions can increase the pressure.

Without open lesions, such as neuropathy, vascular disease and so on, carefully check the foot after exercise, whether the traces of swelling or compression

(if any note inappropriate shoes), once found to have skin ulceration, it is timely to the hospital for treatment .

The principles of diabetic foot wound care

Diabetic foot are a common complication of diabetes, but people tend to diet and drug therapy during a time when blood sugar at the expense of maintenance

and care of the foot, so that it will happen ulcers, gangrene, a serious need for amputations. For a diabetic, the cure of foot ulcers, and treatment of

other organs, like disease, combined treatment should be taken. Medical nutrition therapy is a comprehensive treatment of an important part of diabetic foot,

but it is often patients, and even doctors ignored.

In fact, the importance of nutrition therapy for patients with diabetes. Through nutrition therapy to achieve, maintain or improve the overall health status:

1, through the use of insulin (endogenous or exogenous insulin), oral hypoglycemic agents and sports to make a balance of food intake, so as to achieve and

maintain blood sugar control target range.

2, so that to achieve the desired level of blood lipids.

3, through the ingestion of a suitable heat to maintain the ideal weight for adults to meet children, young people of normal growth and development,

diabetes, pregnancy and breast-feeding women, metabolic needs, illness or wound a variety of nutrients needed for recovery.

4, to eliminate, prevent, delay or control of nutrition-related risk factors and complications (such as low blood sugar, short-term illness), sports-related

problems, kidney disease, autonomic neuropathy, hypertension, cardiovascular and peripheral vascular disease and skin ulceration and so on.

If you are currently suffering from diabetic foot disease, we must bear in mind the nutritional treatment of wounds, some of the basic principles:

1, the wound site must have a suitable micro-circulation;

2, the wound must be kept clean, can not have pollution;

3, wound necrosis organizations must be removed or reduced to a minimum;

4, the wound must not be infected;

5, where skin diseases must be controlled or cured;

6, the friction of the wound, or direct compression must be controlled to a minimum;

7, wounds of the external environment can not be too dry and wet;

8, the patient's nutrition, metabolism and drug must remain stable.

The treatment of diabetic foot infection

Diabetic patients with diabetic foot is the result of local nerve abnormalities and distal lower limb peripheral vascular disease occurred foot infections,

ulcers, and (or) deep tissue destruction. When the diabetic patients affected by cutaneous nerve injury, patients often do not feel squeezed or temperature

changes, making the skin's defense capabilities of various injuries reduced, it may cause repeated injuries to the skin. The treatment of diabetic foot can

be largely divided into the following aspects: surgical treatment: partial care; antidiabetic treatment: anti-infective treatment; vasodilative a

microcirculation regulation.

Local surgical treatment of the appropriate surgical treatment of the wound is very important, for deep infection has already occurred and the location for

the formation of abscess incision and drainage is very necessary, if the existence ulcer surgical treatment should be necessary. Effective way to include the

use of 3% hydrogen peroxide cleaning deep wound, can also be used iodophor gauze drainage. Ulcer should be based on ulcer size and depth, with 3% of the

pairs of ammonia or saline, after washing the wound with povidone-iodine gauze external application. Dry gangrene are available 75% alcohol or povidone-

iodine topical gauze, if necessary, resectability of necrotic toes. Specific circumstances should be based on the patient medication one time a day, at least

every other day dressing a times, a serious condition dressing two times a day. When gangrene occurs when the toe (usually dry gangrene), and sometimes can

lead to necrotizing fasciitis, causing the affected foot localized redness, swelling, fever, pain, skin a dark purple stain, etc. In severe cases, required

to cut the toe or limb amputation and mortality rate is more high. Therefore, according to the clinical circumstances of the removal of necrotic toes. Note

that: when the surgical dressing be sure to remove dead tissue and keep the wound clean, should keep the wound dry, well-defined, limited, pay attention to

maintaining environmental hygiene and to prevent the bedding contaminated wound, for subsequent surgery may be undertaken to prepare .

Local nursing care is a key step in treatment of diabetic foot is one of 10 million can not be ignored. Clinical nursing care generally includes: from the

overall understanding of the patient's basic physiological needs: appropriate health education; to patients and their families, introducing the basics of

diabetes and its complications prevention and treatment methods and experience; from the ideological stability in the patient mood; the same time, patience

and guidance patients self-regulation in order to alleviate or eliminate the psychological barrier of patients and their families to make it in the best

mental state and actively cooperate with the treatment. As soon as possible inform the patient of the following content: foot skin need to be carefully

protected against grasping, scratching, try to avoid abrasions, burns and so on, should not cut toenails too short, wear shoes and socks should loose,

comfortable, no ulcer or injury to per night with warm water (37 ~ 38 ℃) feet, and gently massage my limbs, in order to promote foot circulation cold feet

warm when you pay attention. This shows that surgical treatment of local care is mainly the need to always observe the affected foot local skin color,

temperature, feeling, and whether conditions such as edema and ulceration, abnormal should be dealt with promptly.

Hypoglycemic therapy is an important part of treatment of diabetic foot. Should first be an active treatment of diabetes, controlling blood sugar in the

ideal range, adjust, metabolic disorders, electrolyte imbalance, if necessary, complement proteins, in order to promote wound healing and skin growth.

Infected with more severe cases, oral hypoglycemic agents may be suspended and replaced by intensive insulin therapy, such as subcutaneous injection of

insulin or continuous subcutaneous insulin infusion pump to control blood sugar in an appropriate range. Bed rest during hospitalization as far as possible,

reasonable diet, avoiding foot trauma, burn, so that foot comfort, reduce the incidence of foot ulcers.

Anti-infective therapy as soon as possible the appropriate choice of specimen smears, bacterial culture and drug sensitivity test, etc., such as sputum,

blood, urine, purulent secretions, ulcers and other specimens, specimens of specimens from the best in the use of anti-infective drugs Prior to, and in

particular should be taken to avoid contamination in order to avoid misleading. To obtain reliable results of bacteriology. According to susceptibility test

results choose the appropriate antimicrobial agents according to the actual situation in individual patient administration. However, the clinical reality is

often too late to wait for etiological test results, the majority of cases are treated while checking side. When the mild diabetic foot infection, it can

oral antibiotics 1 ~ 2 weeks, the need to observe the changes in the condition, once the condition worse or continue to develop, it should be changed to

parenteral administration. For patients with more serious disease should be better joint use of antimicrobial agents and to the full dose, full course of

treatment. Is best administered intravenously, improved change after oral. There is a saying within the profession, "diabetes better to use two Su", the

former refers to a good insulin control of blood sugar levels, which is good to use antibiotics to control infection progress. Anti-infective treatment is

medical treatment of diabetic foot is one of the main measures, the main route of administration by intravenous infusion. Even the need for surgical

treatment of diabetic foot, it must first control the infection, and then on this basis, the purposes of surgical intervention, thus a timely and effective

control of symptoms of diabetic foot infection should give high priority clinical issues. The use of antimicrobial agents sterilization of β-lactam-based,

appropriate combination of anti-anaerobic drugs (specifically anti-or facultative anaerobes). Patients according to renal function and other related

parameters set out the administration of appropriate individualized programs to improve drug efficacy and reduce adverse reactions. More varieties of

clinical use at present are: cefoperazone / sulbactam, piperacillin / tazobactam, levofloxacin, cloxacillin, clindamycin, fosfomycin, metronidazole,

tinidazole and so on. Serious illness can be used imipenem / West Division statins, vancomycin and so on. Concurrent osteomyelitis, should continue to give

antibiotics more than 6 weeks.

Vasodilator - regulating microcirculation in the treatment of complications of diabetes, the vasodilator drugs, a micro-cycle regulation is an important

application of one of the measures aimed to achieve through the use of this class of drugs to improve peripheral vascular function of a micro-circulation to

enhance the body's tissues blood supply, reducing hypoxia is conducive to tissue repair and so on. Another important significance to improve the clinical

treatment of diabetic foot infection of local tissue blood circulation, improve anti-infective lesions in infected blood concentration, thereby increasing

the antibacterial effects of drugs.

Leading to the risk factors of diabetic foot

Leading to the risk factors of diabetic foot and diabetic foot follow-up frequency should be based on the type and extent of disease determined.
What is the pathogenesis of diabetic foot?

1, neuropathy is caused by sensory impairment caused by diabetic foot basis

Limb blood vessels and autonomic neuropathy in blood vessels weakened movement, local organizations, lowered immunity, minor trauma can cause infection, but

due to local sensory disturbances, small lesions can not be timely treatment, resulting in the rapid expansion of the wound. At the same time due to physical

sensory dysfunction, but also easy to cause scalding. Neuropathy can cause a small foot muscle atrophy, due to the long stretch muscles non-confrontational

form a claw-like toe and specifically the third, fourth and Toe〕. This deformity to make weight-bearing plantar metatarsal head as the anchor, due to

friction, there is the formation of the corpus callosum, vulnerable to infection, and penetrating ulcers, severe cases, spread to the bone near the bone

caused by inflammation. As the joint movements of deep sense of loss and reflection obstacles, so that the patient is not conscious of the circumstances,

some joint overload, loss of repeated trauma on the protective effect, so that the joints and articular surface of the rules has become very easy to fracture

, joint dislocation and subluxation, especially the metatarsophalangeal joint.

2, lower extremity ischemia occurred atherosclerosis leading to the foot, prompting diabetic foot may occur

After the lower extremities caused by arteriosclerosis occurred foot ischemia, especially in the toes, coupled with the small blood vessels and microvascular

disease, so that toe blood pressure, systemic blood pressure down to half or less. Patients often asleep at night due to toe pain to get up and walk a few

steps in order to alleviate the need. In some cases requiring a rapid increase blood circulation situations (such as trauma, infection, cold and hot, etc.)

can not be a corresponding increase in blood flow can cause gangrene, particularly toes staggering.

3, diabetic foot infections are caused by the fuse

Neuropathy and ischemic easily lead to local trauma, secondary to severe infection. In the minor trauma such as the foot of the pressure sores, toenail

trimming too short, athlete's foot can be caused by improper treatment of secondary infection. Plantar pressure overload in the area of the skin and

subcutaneous adipose tissue may be fibrous thickening, once the heel has been infected, easy to spread quickly to four weeks, ligament injuries can the

spread of infection, causing metatarsal osteomyelitis. The degree of ischemia occurs under wet, dry and mixed gangrene.

Leading to the risk factors of diabetic foot

(1) The duration of diabetes more than 10 years;

(2) Long-term blood glucose control is poor;

(3), wearing inappropriate shoes, foot health is poor;

(4) foot ulcer's past history;

(5), neuropathy symptoms (foot numbness, feeling of touch or pain diminished or disappeared), and (or) of ischemic vascular disease (exercise-induced calf

pain or fat cool);

(6) signs of neuropathy (foot fever, the skin does not sweat, muscle atrophy, eagle claw-like toes, pressure points, skin thickening, a good pulse, blood

filling sound), and (or) signs of peripheral vascular disease (foot-fat cool, shiny skin, thinner, pulse loss and subcutaneous tissue atrophy);

(7), diabetes and other chronic complications (severe renal failure or kidney transplant, it is obvious retinopathy);

(8) neurological and (or) vascular disease is not serious and there is a serious foot deformity;

(9) other risk factors (decreased visual acuity, affected the function of the orthopedic foot problems such as knee, hip or spinal arthritis, inappropriate

footwear;

(10) personal factors (socio-economic conditions of poor, elderly or living alone, refused treatment and care; smoking, drinking, etc.);

(11) delayed diagnosis of diabetes.

The frequency of follow-up of diabetic foot disease should be based on the type and extent of. For example, the plantar ulcers in patients with referral

should be ground, we could have a ~ 3 weeks review once; foot sensory loss in patients can return visit once every 3 months.

Grading treatment of diabetic foot disease

Diabetic foot is a peripheral neuropathy (including autonomic neuropathy), microvascular disease, macrovascular disease and bad health habits such as the

result of many factors. Diabetic foot lesions is based on the nerve and vascular disease, infection worse. Diabetic foot disease in a variety of reasons, in

order to facilitate the treatment and care, clinical diabetic foot disease will be divided into six:

0: Skin integrity, no open lesions. Foot ulcers occur mainly in high-risk groups, such as associated with peripheral neuropathy, autonomic neuropathy,

peripheral vascular lesions; elderly; those who live by themselves; blind or severely visually impaired and can not observe their own foot lesions; diabetes

lack of knowledge of persons; sense of missing persons; combined kidney lesions; associated with foot deformities, foot calluses were.

Treatment: regular follow-up, step up publicity and education, prevention of diabetic foot disease.

1: Foot skin ulcers, there is an open lesions, such as blisters, Xuepao, corns or calluses cause frostbite or skin burns and other superficial ulcer not

involving the deep tissue.

Treatment: debridement, removal of all necrotic tissue, preventing the development of ulcers to deep. Proper use of vasodilators, blood circulation drugs,

such as prostaglandin E1 agents, anti-platelet aggregation drugs, to improve microcirculation, reduce blood viscosity, reduce thrombosis and minor seepage;

application of B vitamins, nerve growth factor and other drugs, in order to improve peripheral nerve function.

Level 2: deep penetrating ulcers, often associated with skin and soft tissue infections, more bone-free inflammation.

Treatment: debridement to remove all living tissue loss and comprehensive exposure to the wound, full drainage of pus, antibiotics to control infection.

Large ulcers, severe infections, it is appropriate insulin controls blood sugar, diet appropriate increase in protein quality and attention to blood lipids

and blood pressure control.

Level 3: deep ulcer, often affect the bone tissue, there is deep abscess or osteomyelitis.

Treatment: wide debridement, incision, drainage of purulent organization, for bacteriological culture, the joint application of antibiotics. Hypoproteinemia,

malnutrition, patients should be strengthened to support treatment, if necessary, infusion of plasma, albumin or amino acid solution.

4: ischemic ulcer with gangrene (necrosis), the surface will have infection of necrotic tissue.

Treatment: lower limb vascular occlusion, the hyperbaric oxygen treatment helps to improve the oxygen situation and reduce the edema. Lumen occlusion greater

than 50% of patients, available methods of vascular reconstruction or replacement in order to improve or restore limb blood perfusion index. At present, use

of angioplasty plus autologous bone marrow stem cell transplantation for treatment of diabetic foot disease reported that the method can suffer from foot

grow new blood vessels to replace the already necrotic blood vessels, in order to avoid amputation.

Level 5: gangrene affects the entire foot, all of infection or ischemia, expressed as wet or dry necrosis, often affecting the ankle or leg.

Processing: This stage of serious foot lesions, usually amputation should be implemented. Post-amputation patients in need of rehabilitation as soon as

possible to resume the use of artificial limbs to walk. As the side of the amputation, the other side of the lower extremity ulceration or gangrene of the

possibilities, so patients need to enhance awareness of foot protection.

The performance of diabetic foot lesions varied, treatment and care, each using a different approach, but it is a preventable, treatable disease. I believe

that under the guidance of diabetes specialist in every one of the efforts of diabetes, diabetic foot disease must be able to minimize the harm.

Diabetic foot care and common sense

A large number of survey data indicate that diabetic foot disease will not only greatly reduce the quality of life in patients with diabetes, but also

causing enormous economic and social burdens. In China, the incidence of diabetic foot patients with diabetes account for about 2.6% ~ 5.2%, amputation (toe)

rate of about 14%, the cost of their treatment in hospital for other reasons than the same period in diabetic patients is much higher. It can be said of

diabetic foot disease is a serious complication of diabetes, one of the most horrible. A day before going to bed with warm water (38 ℃ or so) soak your feet

15 to 20 minutes, check whether there feet blisters, wounds, scratches, etc., and check between the toes and carefully dry.

2, do not arbitrarily cut corns or scab, nails do not cut too short in order to avoid ingrown toenails.

3, the winter should pay attention to the feet warm, wearing cotton socks, cotton shoes, remember not to use hot-water bottle, electric heaters or direct

Kaohuo heating, so as not to burn.

4, buy new shoes, to loose, comfortable and suitable. Slightly wider than the foot, breathable and have a certain hardness of the square head soft leather

shoes, sport shoes the best, do not wear high-heeled, pointed, hard and plastic shoes. In addition, shoes should be out regular checks of the existence of

foreign body, so as not to injure his feet.

5, socks to cotton is better, do not wear a patch or a crevasse of the socks, to prevent uneven pressure on the feet and affect blood circulation.

6, if the feet drier can be coated thin layer of moisturizer to prevent skin cracking.

7, foot deformation in patients with diabetes can choose the protection of special shoes, such "tailored" to protect the fragile skin shoes can effectively

disperse the pressure point to prevent diabetic foot disease.

8, to avoid foot acupuncture treatment, to prevent accidental infection.

Signal treatment

1, numbness, swelling, pain.

2, foot skin temperature drop.

3, foot skin color red, to dark.

4, the foot has ingrown toenails, calluses.

5, foot trauma, such as broken skin bleeding, burns and so on.

When the above-mentioned abnormalities, they should promptly go to the hospital treatment, so as not to increase the development of diabetic foot lesions.

Pure skin irritation who can be properly reduced activity, changing the soft cloth shoes, and ring around to do massage, movement should be gentle, to avoid

pushing, rubbing, kneading and other skin damage action. If no improvement within a week, should be timely treatment.

Care of diabetic feet remember 16 tips

Although the treatment of diabetic foot disease is still very difficult, but simple precautions can be effective. Only patients themselves, their families,

or status to the doctors the patient's shoes and socks off, check the patient's feet, they can exceed those of high-tech inspection project role in ensuring

that the feet of diabetic patients, "no worries." Diabetic foot prevention and care was particularly important, with particular emphasis on adequate

protection, which is also the slogan of this year's World Diabetes Day content. In fact, diabetic foot home care is very simple and very useful. If the stick

is fully capable of preventing diabetic foot tragedy.

Liwan Hospital of Guangzhou Medical College Department of Endocrinology, Professor Luo Hongbin, director of a group of specially produced vivid illustrations

painted foot care, according to diagrams, WANG Yu-Zhen, LUO Hong-bin two experts pointed out that nursing homes should be below 16 foot-pronged approach:

A day with warm water and non-irritating soap wash feet, soak 5 minutes, with white towel (with white towel is mainly to discover whether the damaged foot).

Xi Jiaoshui the temperature of 40 ℃, is the hand-Mo Shangqu will not burn. People often advocated scalding with hot water legs, that hot water can relieve

fatigue feet, but for diabetic patients is concerned, in order to avoid scalding, it is recommended to use warm water is better. Between the foot and toes to

keep dry, easy-out Jiaohan patients use non-irritant powder (such as talcum powder), dried after the application of foot.

2, foot dry skin care products are coated (such as Vaseline, silicon cream, etc.).

3 Check your feet every day. If patients with severely impaired vision, and the family should be helped; if patients are old, you can check with a mirror.

Note Check foot.

4, Paowan foot and nail trimming time. Toenail trimming should be flat, do not cut bleeding. Older patients may request to help their children. Some patients

are very thick nails can be serviced by a professional using a special flat toenail scissors toenail scissors.

5, when the corpus callosum occurs, the first careful not to cut their own, as is very likely to trim broken. Conditional treatment of patients can wear a

special shoe, shoes with uppers made of special elastic material, soft thick crust, accompanied by special insoles, plantar pressure can be dispersed to

reduce the formation of the corpus callosum. If you can not buy treatment of shoes, you can buy a loose, comfortable soft-soled shoes. Do not always wear

shoes, because shoes can cause the heel of the corpus callosum.

6, there corns must please the professional medical care, do not let the street people pedicure repair.

7, wearing a clean and comfortable cotton socks, socks, tight blood circulation will affect the feet. Can not wear socks with holes and patches, but also can

not wear non-absorbent nylon socks, cotton socks to choose to relent.

8, can not walk barefoot. Do not walk barefoot at all times to avoid foot skin damage. In particular, can not walk barefoot on the beach. The best at home,

wear soft bottom shoes. Choose sandals can not vote for plastic slippers.

9, shoes should lenient, permeability is better. The beginning of new shoes to wear shoes when you want to check whether the foreign body, old shoes have

regular inspections. Do not wear new shoes more than half an hour the first day of the next day, wearing no more than 1 hour and then gradually extend the

time for wearing new shoes. Do not barefoot shoes do not wear toe sandals sandwiched. Heel is not too high.

10, to avoid scalding. Mattress can not be electricity in winter and hot-water bottle, not washing sauna, do not warm-based home therapy instrument.

11, to avoid frostbite. Exercise wear warm winter shoes to go out, if the shoe was wet snow should be replaced on time.

12, to prevent bad behavior. The first is to quit. Smoking can cause vasoconstriction. Smoking serious likely to have peripheral vascular disease. Second,

not a long time Alice Erlang Tui, so as not to impede lower limb circulation.

13, due to the trauma caused by infection, even a small ulceration occurred also immediately after washing with saline, using sterile gauze bandage

(preferably to the hospital by a doctor processing).

14, after the blisters break easily cause a bacterial infection, ulceration, formation of cellular inflammation. Out the best way to prevent blisters is to

avoid burns, avoid excessive friction. If do not wear too tight shoes, the sun very strong in areas such as in the foot sunscreen.

15, medical treatment, the reminder doctor check your feet. Nails embedded in the meat, when a doctor to help. When paronychia (for nail around the swelling,

pus, etc.) immediately for medical treatment.

16, as far as possible blood glucose, blood pressure and lipid controDiabetic foot care and common sensel to the normal range.

Stem cell transplantation to deal with diabetic foot

Diabetic foot is a common complication of diabetes, was seriously ill and even those who face the risk of amputation. Recently, Zhejiang Province, the first

Chinese medicine hospital in the province to adopt a stem cell transplant technology, so that patients with diabetic foot saw the hope of treatment.

71-year-old Town of Xiaoshan Puyan Kong Dabo suffering from diabetic foot, a manicure last year, when he accidentally torn right toes, ulcerated wounds

unhealed, after a week went so far as rotten to the bone, the entire right foot cold and black, allowing uncle suffered enough. Provincial Hospital of

Chinese experts in the diagnosis, which is typical of diabetic lower limb vascular disease caused by bad foot. In order to enable patients to relieve the

pain of amputation, diabetes experts, NI Hai-xiang Provincial Hospital of Chinese physicians using stem cell transplantation bold new technology.

This called "autologous peripheral blood stem cell transplantation," the new technology is to human bone marrow hematopoietic stem cell mobilization into the

peripheral blood, and then separating out the useful hematopoietic stem cells, and then re-enter into the affected area, stem cells in the "new posts" on the

be effective, the gradual formation of new blood vessels to replace the original lesion of the blood vessels, improving and restoring lower limb blood flow,

and then by 3 to 6 months of recovery, the new blood vessels can grow into, so let the diabetic foot, "old tree grows new branches "avoid the risk of

amputation.

At present, the original Kong Dabo sick have recovered the body temperature and blood, skin from black to red, the condition improved markedly. It is the

province the first use of autologous peripheral blood stem cell transplantation technology used successfully in the treatment of diabetic foot.

Prevention of diabetic foot must know 9 tips

On the prevention of diabetic foot, the patient must clearly understand the nature of the disease, including neurological diseases and ulcer risk. Patients

must clearly understand the nature of the disease, including neurological diseases and ulcer risk. This is sometimes difficult to know, with understanding

and problem should do the following:

(1) regular checks your feet, including blisters, cuts, scratches, nail problems;

(2) regular checks of shoes, with or without foreign bodies and rough places;

(3) Keep feet clean;

(4) shoes and socks should be relaxed;

(5) Do not walk barefoot;

(6) Do not heat or foot;

(7) Do not over-prune foot calluses, or coated irritant drugs;

(8) to be careful when cutting nails;

(9) not to smoke.

Advised diabetic friends:take care foot from now

Patients with diabetes prone to foot disease, seriously affecting the patient's quality of life. However, the diabetic foot can be prevented is also, in

addition to strict control of blood glucose, the most important thing is to develop good foot care habits.

1 day, clean feet with warm water and soap, then wipe with a soft clean dry towel, paying particular attention to whether dry between the toes. Feet, the

water temperature before you try their hands in order to avoid burns, do not soak in water for a long time will be your feet, if the dry skin should be

coated with lotion.

2, trimming toenails straight-time application clippers horizontal shear, not to cut toenails too short, do not cut deep to the corner position, so as not to

damage the skin.

3, choose natural materials soft socks, such as cotton or wool socks, to avoid through the tight nylon stockings.

4, choose the right shoes. Buy shoes should be valued the level of comfort, choose a solid heel, wide toe style; to avoid wearing leather material, too sharp

or too tight toe shoes; should choose leather or breathable cotton and good shoes.

5, do not wear new shoes for a long time as far as possible Qinhuan shoes, the feet the same location to avoid the long-term pressure to prevent foaming or

bruises.

6, do not use a heating pad or electric products warm feet, so as to avoid feeling sluggish and burns.

7, do not walk barefoot in the room, or walking on the carpet should also wear slippers.

Prevention and treatment of diabetic foot

After the formation of diabetic foot ulcers often long treatment, foot gangrene has often had to cut plastic, resulting in permanent disability of patients,

it is extremely important to the prevention of diabetic foot. Weed control of blood every day to insist on weight, taboos tobacco, alcohol, pay attention to

foot health, is a fundamental measure for prevention of diabetic foot. The specific measures are as follows:

(1) wear loose, wide, soft, breathable cloth shoes or shoes, or high-heeled shoes to avoid wearing cool light. To keep shoes dry, shifts in the same time a

few pairs of shoes to wear. Wearing new shoes, especially the new shoes, began to be a short time try to make legs slowly adapt to the new shoes, and feet

should always double-check whether the skin red, swollen, bruised, even for minor injuries, but also the immediate replacement of shoes, while the wound be

treated accordingly. To select a fit of cotton socks or wool socks, to Qinhuan Xi Wazi, do not wear socks with elastic mouth, so as not to affect the blood

circulation of the foot.

(2) feet per day must carefully check whether there are minor injuries such as abrasions, laceration, water sore and so on, should pay special attention to

check the toe joints and the soles of the feet. A small laceration would give rise to infection, prolonged unhealed, minor injuries may also be the beginning

of a serious gangrene. Insensitive because of diabetic foot or lose, it is sometimes subject to damage that may not know, so it is necessary to stress that

to check every day again.

(3) Daily feet with warm water and neutral soap, water temperature should not exceed 40 ℃. Feet soak 5 to 10 minutes later, that is, wipe with a soft dry

towel to, toe crevices do not residual moisture.

(4) dry feet a little vegetable oil evenly after the application may be available in the feet, then gently massage a few times, remove the scales and

significant keratinization layer. If the Khan foot can be a little talcum powder on the withdrawal.

(5) pairs of socks to wear in winter can be given the use of care Socks or night, shall not use electric blanket and hot-water bottle, nor sunlight exposure.

(6) Do not use tincture of iodine and other potent disinfectant, non-detrimental to the skin of the tape posted. Trimming nails, calluses or corns and

prevent damage when.

(7) actively prevent and treat infections. There are athlete's foot must be completely cured. In addition, we must pay attention to prevent infection in a

ditch.

(8) the absolute prohibition of smoking, because smoking can cause vascular spasm and aggravate ischemia, and should avoid passive smoking, that is, family

members should also quit smoking.

The principle of treatment of diabetic foot are as follows:

① active control of diabetes. By regular diet control, oral drugs or insulin lowering bad treatment, allows blood glucose control in normal or near normal.

Foot gangrene should use insulin.

② active debridement of local trauma treatment. Day after local debridement may be deposited with antibiotics, insulin and improve the pride cycle of drugs.

③ The dipyridamole, enteric-coated aspirin, to lower blood viscosity, prevention of thrombosis.

④ applied to improve the emblem of the cycle of drugs, such as henbane alkali drugs, Salvia, prostaglandin E and low molecular weight dextran and so on.

⑤ antibiotic treatment, infection control.

⑥ hyperbaric oxygen therapy can help to improve the oxygen situation, the effect very well.

⑦ are deficient in zinc. Gangrene due to diabetes patients had a zinc deficiency, so that human cells can not play their normal function, delayed wound

healing. Zinc supplementation can improve the immune function of t to enhance tissue repair. Can be used for each 22 mg of zinc sulfate per day 2 ~ 3 day

service.

⑧ added a variety of neurotrophic agents.

⑨ the above method is invalid when feasible amputation (toe), or arterial reconstruction.

Winter to protect "second heart"

Medical studies suggest that the feet are the body's "second heart", showing that foot in the human health in an important position. Once the feet are sick,

you can affect the whole body healthy, which is much more prominent diabetes. According to reports, the United States of all diabetes patients, 20% of the

patients due to foot infections and other complications hospitalized with diabetes foot infection due to an amputee, all non-traumatic amputations accounted

for 25% -50%, Therefore, people with diabetes should pay attention to foot health.

Patients with diabetes, mostly the elderly, the decline of its defense capabilities, and the pairs of the liver under the subcutaneous fat reduction in cold

diminished capacity, when the feet are cold stimulation, can cause local vasoconstriction. While the feet and the nasopharynx are closely linked, so the cold

feet, may cause the reverse manner nasopharynx vasoconstriction, so that the activities of the nasal cavity within the cilia slow down, the drop in disease

prevention, hidden bacteria in the nasopharynx are took the opportunity to active and susceptible to colds and upper respiratory tract infections, and may

thus complicated by bronchitis, pneumonia, myocarditis and so on. Those patients with chronic bronchitis, etc. See who can make chronic disease increase, or

even serious consequences.

With diabetes, multiple vascular dysfunction and neuropathy, resulting in local blood circulation foot barrier, nutrition disorder and partial insensitivity,

partial resistance to low. Daily activities, it is inevitable fall, collision injuries, lower extremity skin and therefore damage occurred; foot fungal

infection in the formation of tinea pedis, and often easy to secondary pyogenic bacterial infections; elderly patients unwieldy because of hands and feet,

nail scissors, when, incoordination, easy to damage the skin, they can often become a reason for diabetic foot infections, and easy to develop into chronic

ulcers, or even difficult to control severe infection or gangrene, and sometimes forced to amputation, or because of foot infection spread to the body growth

and reproduction of bacteria into the blood circulation produce toxins caused by sepsis, a direct threat to the patient's life.

It was observed that the foot temperature should generally be maintained at 28-33 ℃, when the body feels comfortable, if less than 22 ℃, due to local

vasoconstriction, affecting systemic blood circulation can occur from respiratory or cardiovascular side effects. Therefore, diabetes should not be a long

sit-in, according to physical and health conditions should be regular physical activity, such as walking, jogging, kicks, playing tai chi, sword, etc., can

improve lower limb blood circulation, enhance cold capacity, there are help lower blood sugar; another to elect to wear loose cotton-padded shoes or hair,

often for Xi Wazi to keep feet dry; bedtime of around 45 ℃ warm water with their feet or 10-15 minutes to warm and the cold will help improve local blood

circulation; wear a good non-slip shoes, walking carefully to guard against falls; suffering from athlete's foot for their active treatment, avoid using

Shousi feet itching skin and rub the toes to prevent skin damage caused by pyogenic bacterial infection.

Prevention of diabetic foot amputation should be treated as soon as possible

After years of continuous improvement of methods of treatment of diabetic foot Despite the fatality rate decreased significantly, but morbidity remains high,

so that many quality of life in patients with diabetic foot declined significantly. Diabetic foot is a result of diabetic neuropathy and the microcirculation

and the loss or illness infected foot lesions. It is an important chronic complication of diabetes, despite the physical and mental health hazards for

patients with diabetic foot a huge serious amputation and even life-threatening, but as long as the patient as soon as possible, timely hospitalization,

doctors will be able to monitor a full course of the disease, we can adopt a scientific treatment and care programs. After treatment can often relieve the

symptoms of diabetic foot, slow down the development of diabetic foot disease, if proper care and can even prevent diabetic foot was amputated.

Early detection followed up inspection

After years of continuous improvement of methods of treatment of diabetic foot Despite the fatality rate decreased significantly, but morbidity remains high,

so that many quality of life in patients with diabetic foot declined significantly. Clinical evidence, if early detection of diabetic foot and to give

appropriate treatment is able to prevent its occurrence and development of. How can I do early detection of diabetic foot? The correct approach is: may occur

in patients with diabetic foot diabetic foot on a regular basis, strict, laws, to conduct focused inspections followed up. Diabetic Foot mostly occurs after

the age of 50, to 60-70 years of age is most prevalent. The new obesity diabetes, longer duration and poor control of blood sugar often cause blood sugar

fluctuations are often a good-risk population. Almost by the occurrence of diabetic foot ischemia, neuropathy, infection of these three major factors work

together. Thus, diabetic foot forecasting and early detection also should be these three aspects.

Guard against multi-pronged approach

Followed up for examination is only the first step in prevention and treatment of diabetic foot for a specialist hospital for diabetes, only the first step

is not enough, there should be set missionary, inspection, treatment and care of diabetic foot in one of the professional studio. Through advanced

monitoring, treatment, care and professional treatment equipment, health care practitioners, around the etiology of diabetic foot - ischemia, neuropathy and

infection, to provide timely medical services. Lu Wen-Yan reminder, in addition to a timely hospital treatment, diabetic foot wounds in patients with normal

foot should be avoided, for small lesions should also be disposed in time, efforts should be made to achieve the following prevention measures:

1, smoking cessation. In order to prevent vasospasm and increase the resultant tissue ischemia and hypoxia;

2, pay attention to maintaining foot health. Such as the feet with warm water every night, after a good wash with the soft towel, pay particular attention to

toe sutural clean, anti-fungal infection; right Jiaohan many patients can be enough to wipe the bottom and some talcum powder toe sutural; Qin nail scissors

to avoid damage caused by secondary infection of a ditch, shoes, elastic should be appropriate and in the winter to keep warm to prevent frostbite of foot;

3, to avoid all kinds of foot injury;

4, if found, including corns and other foot lesions, should promptly seek medical treatment; such as local infection, even for minor infections, should also

be under the guidance of a doctor as soon as possible the use of antibiotics, infection control, to prevent further deterioration;

5, such as severe gangrene, surgical treatment must be to prevent exacerbations, life-threatening.

The performance and treatment of diabetic foot

Due to neuropathy, dry skin, no sweat limb; extremities tingling, burning, numbness, feeling sluggish or loss, showing sock-like change, foot batting sense

of belonging; due to acral malnutrition, muscle atrophy, flexor and extensor loss of normal balance of traction tension, so that subsidence caused by the

bone joints between the toes bending, forming arched feet, hammer toes, foot deformities such as chicken feet toe. The clinical manifestations of diabetic

foot:

(1) the general performance of the foot: Due to neuropathy, limb skin dry without sweat; extremities tingling, burning, numbness, feeling sluggish or loss,

showing sock-like change, foot batting sense of belonging; because acral malnutrition, muscle atrophy, loss of normal flexor and extensor balance of traction

tension, so that the bone joints between the toes of subsidence caused by bending, forming arched feet, hammer toes, chicken feet and other foot deformities

toe. When a patient's bone and joint and soft tissue strain occurs when the patient continues to walk prone to cause bone and joint and ligament damage,

causing multiple fractures and ligament rupture, the formation of Charcot joints (Charcot). X-ray bone destruction over there, and some small bone fragments

from the periosteum of gangrene caused by sequestrum affect healing.

(2) ischemia mainly: Common skin malnutrition muscular atrophy, dry skin elasticity is poor, relying on hair from the skin temperature decreased, there is

pigmentation, acral arterial pulse weakened or disappeared, vascular stenosis at vascular murmur can be heard. The most typical symptom is intermittent

claudication, rest pain, squatting difficult to stand. When patients have damaged or spontaneous limb skin blisters after infection, the formation of ulcers,

gangrene or necrosis.

(3), diabetic foot ulcers can be classified according to the nature of neurological disease ulcers, ischemic ulcers and mixed ulcers. Neurogenic ulcer:

Neuropathy played a major role in the etiology of the blood circulation good. This foot is usually warm, numb, dry, the pain is not obvious, the foot

arteries fluctuation good. And have enough nerve lesions can have two consequences: nervous ulcer (mainly occurred in the foot) and neural arthropathy

(Charcot joints). Ischemia-induced foot ulcers, non-neurological disease, is rare. Nerve - the same time, these patients with ischemic ulcers are peripheral

neuropathy and peripheral vascular disease. Dorsalis pedis artery fluctuations disappear. The foot is cool these patients, and may be accompanied by rest

pain, foot ulcers and gangrene the edge of the Department.

Foot ulcers more common in the former site of foot, and often repeated was caused by mechanical stress, due to peripheral neuropathy caused by the

disappearance of protective sensation, the patient can not feel the pressure of this abnormal change, can not take some protective measures in place after

the ulcer concurrent infection, difficult to heal ulcers and ultimately gangrene.

Treatment of diabetic foot:

(1) to focus on prevention, try to avoid foot injury, such as wearing loose fit of the shoes and socks so as to avoid wear and tear the skin; such as poor

eyesight, do not self-cut nails; feet with warm water to avoid burns and so on.

(2) General treatment: In addition to strict control of blood sugar, improve whole body health levels, to eliminate some known risk factors for vascular

disease, such as the treatment of high blood pressure, lower blood fat, quit smoking and so on.

(3) removal of edema: As long as there is edema, all of the ulcers are difficult to heal, this has nothing to do with the causes of ulcers. Can be used

diuretics or ACE-I treatment.

(4) infection in treatment: a foot infection patients, especially those with osteomyelitis and deep abscess, and they should in the monitoring of blood

glucose, based on intensive insulin therapy in order to reach or near-normal blood glucose level. According to the results of bacterial cultures and drug

susceptibility testing to choose suitable antibiotics. Superficial infection of the organization may be granted partial debridement and broad-spectrum

antibiotics, such as cephalosporin Gac Linda ADM (clindamycin can be a very good access to organizations, including the difficult to access the diabetic

foot); should not be singled Enzymes using cephalosporins or quinolones as antibacterial spectrum of these drugs does not include anaerobic bacteria and some

G + bacteria. Oral treatment can last for several weeks. Deep infection of these antibiotics are available, but it should begin from the intravenous

administration, but also require surgical drainage, including the removal of infected bone tissue, and amputation.

(5) surgical treatment: refractory ulcers can be surgically treated. When the diabetic foot infection or gangrene affecting the foot most of the post and the

central, the surgeon must choose to major amputation in patients with conservative treatment, or as much as possible.

Shock! Diabetic foot really so terrible

Diabetic foot disease is a peripheral neuropathy (including autonomic neuropathy), large vascular disease, and poor foot health and many other complex

interactions between factors caused. The size of the role of each factor varies, and may also vary by race; For example, in some Asian populations,

surrounded the role of vascular lesions may be lighter. Consequence of this is due to its lower extremity amputations, and therefore one of the most feared

complication of diabetes.

Compared with the general population, diabetic patients with lower limb amputation and opportunities must be 15-40 times higher. In the elderly at higher

risk. However, if the active treatment, the majority of amputations can be avoided. Disappearance of peripheral neuropathy with pain is the most common

causes of foot ulcers. The foot is followed by poor sanitation reasons. This type of nerve lesions and ulcers can be without pain.

Peripheral vascular disease can also cause foot ulcers. This ulcer prone to pain. Peripheral vascular disease of the nervous nature of the main difficulties

in ulcer healing. Nervous increasing pressure ulcers occurred at the site, usually the plantar surface. Reported the occurrence of most part of it is caused

by inappropriate shoes, toes on the back of the nerve occurred in the ulcers, the formation of the corpus callosum is also a result of this pressure.

In order to ulcer healing, the need to reduce local pressure (to remove calluses, wearing the right shoes, or vacuum pads). Vascular ulcers occur in the toe

and heel.

In order to ulcer healing, the need to improve the blood supply. Should be actively control the infection. Antibiotic treatment often require a sustained

multi-weeks or months. Attention should be paid to the infection and debridement of necrotic tissue in a timely manner. Refractory ulcer that eventually led

to the most common cause of amputation.

Routine examination feelings or dorsalis pedis artery pulse was found to foot ulcers occur at the most risk to health methods. In the community, it is best

to use a single 5.07/10 g Semmes Weinstein nylon determination of feeling. Single nylon filament detection method is a simple and inexpensive sense detection

method. When the imposed 10 cracker when it will bend.

If the patient does not feel this pressure could be that there is only foot sensory loss. Right has made it clear in patients at risk for foot care education

should be higher than for other sensory and circulation of diabetic patients with good education more detailed and practical.

At present, not yet satisfied with the treatment of painful neuropathy approach. Useful way of including the strengthening of metabolic control and the use

of simple analgesics, tricyclic class of antidepressants or anti-seizure drugs to relieve pain. Will enable the patients believe that pain is not the reason

leading to limb amputation.

Such as very poor blood glucose control, foot infections and ulcers can be in the absence of nerves and peripheral vascular disease cases occur due to poor

foot health. In this case, in addition to strengthening the control of blood sugar, but also asked the patients to wear shoes in order to reduce the chance

of foot injuries. Such as shoes, must wear clean socks!

Diabetic friends how to care enough to foot

Got diabetes, we must pay attention to protect their feet, it will be very easily lead to serious consequences. 1, to a bright office on a regular basis to

check your feet, toes, and foot examination with the mirror. See if there is broken skin, blisters, swelling, discoloration, athlete's foot and corns.

Second, we should seriously and carefully take care of small wounds. Disinfectant should be used (avoid using iodine or gentian violet) thoroughly clean the

wound, and then covered with sterile gauze. After three days, if still no wound healing, medical treatment as soon as possible.

Third, to keep the skin lubricated and foot dry foot. Shuang foot powder can be sprinkled on the toe sutural, shoes and socks Lane; can use lotion or cream

to keep the foot nutritional soft skin moisture.

Fourth, we must Qinhuan Xi Wazi, kept clean. Socks should be a good absorbent, soft and warm and good air permeability. Especially in pure wool or cotton

products better. Socks should be elastic mouth moderate, does not affect the blood circulation of the foot.

Fifth, we should carefully selected and carefully check the shoes. Shoes should be the right size, toes large, the permeability is good. And the texture

soft. Shoes before the shoe should be checked if there were foreign objects or uneven areas. In particular, when you wear new shoes, the first day of no more

than half an hour, check the foot only when no compression or friction wear.

6, to the proper nail trim. Should generally be in the feet, the nail trim is as soft time. Pruning shears should be flat, do not cut too short, do not want

to nail edges rounded or acute angle than the Xiucheng to avoid skin damage a ditch.

7, do not use hot water hot feet. (Xi Jiaoshui temperature should be less than 40 degrees Celsius), general foot soaking time should not exceed 5-10 minutes,

and feet should be used before your hand, elbow or a thermometer measuring temperature.

8, do not use irritating soap. Foot of the Fei River suitably mild soap, and feet should be thoroughly dried after, especially the foot sutural position.

9, do not force the foot rub. Feet, a soft towel after suitably foot skin pairs of interdigital skin of highly absorbent towel is available gauze gently

suck.

10, do not use electric blanket, hot water bottle and the heater warm feet, because they may perceive pain before you, foot skin has been burned. Heating may

choose to wear a thick, soft socks, or foot care.

11, do not use corrosive chemicals arbitrarily remove limbs on the corns, calluses, or tinea pedis. External hard paste, the chicken eye ointment or

corrosive acidic acid drugs often cause skin ulcers.

12, do not walk barefoot. Whether indoors or outdoors, do not walk barefoot or wear sandals barefoot, slippers to prevent foreign body injury in the foot

skin.

Two possible of diabetic foot

Sense of feeling pain in patients with diabetic lower limb should pay attention to the following two possibilities:

(1), diabetic lower limb vascular disease, mainly manifested as lower extremity pain, intermittent claudication, rest pain, lower limb and foot gangrene.

Early physical examination can be found insufficient blood supply to lower limbs, such as lower limb elevation when the foot skin pale, drooping was purple

by the foot cool hair, dorsalis pedis artery pulse weakened and even disappeared; intermittent forced to line refers to the patient is walking suddenly felt

lower limb feeling pain unbearable, and even limped to walk; rest pain, lower extremity vascular disease is the further development of the result, lower limb

is also pain when walking; illness occur the further development of gangrene. The prevention and treatment should pay attention to:

a, strict control of blood sugar and high blood pressure good.

b, note that the foot health, to protect the feet dry and clean, the water often doubt their feet to prevent foot injuries.

c, to improve lower limb circulation: Note the feet warm, smoking cessation, may be long-term application of vasoactive drugs and lower blood clayey nature

of the drug.

d, once the diagnosis of diabetes, lower extremity vascular disease was established, should be actively treated, so as to avoid illness caused by expansion

of disability and death.

Treatment measures include: anisodamine 654-2 Huoxuetongmai drugs, antibiotics, infection control, Chinese medicine treatment has some effect, vascular

bypass surgery can effectively improve lower limb circulation.

(2), diabetic peripheral neuropathy: such as diabetes, peripheral neuritis, mainly for the physical feeling pain, numbness, paresthesia, if burning, ant-line

sense, touch sensitive, there are patients out "at the foot did not root", "like a on cotton, "and easily fell. The prevention and treatment should pay

attention to:

a, good blood sugar control.

b, large doses of vitamin: If B family, vitamin C, vitamin E.

c, vasodilators:

d, inositol drugs.

e, aldose reductase inhibitors.

f, traditional Chinese medicine.

To be investigated lower extremity vascular color Doppler flow image or leg to see whether the blockage of blood vessels and blood flow of lower limb, but

also check to see lower limb EMG, or muscle pain is a nerve prototype prototype. And symptomatic treatment.

Diabetic cause gangrene very self assertive

Most of diabetic gangrene occurred in the elderly; male than female, male to female ratio is 3:2; course of the disease an average of about 10 years, parts of lower limb gangrene more common. The characteristics of diabetic gangrene

Most of diabetic gangrene occurred in the elderly; male than female, male to female ratio is 3:2; Cho scorpion? / A> course of the disease an average of about 10 years, parts of lower limb gangrene more common, accounting for 92.5%, upper limb rare, about accounted for 7.5%; unilateral incidence of about 80%, bilateral disease at the same time about 20%; toe and gangrene of the foot at the same time more common, accounting for 77.5%; toe and calf at the same time, 5% gangrene, leg gangrene accounted for only a 5%; toes or fingers disease accounted for 12.5%.

Clinical types of dry gangrene, wet gangrene, gangrene three kinds of hybrid.

(1) wet gangrene. Acral surface erosion of local soft tissue to form a shallow ulcer, followed by ulceration in-depth muscle, rather then the rotten broken tendon, bone damage, a large number of tissue necrosis, the formation of large abscess, and expel more secretions. This type of gangrene more common, accounting for 72.5%, mainly based on pathological microvascular basement membrane thickening due to microcirculation.

(2) Dry gangrene. Peripheral involvement acral necrosis, withered and black, lesion boundaries clear, to a certain stage of development will be handled on their own without falling. This type of gangrene or about 7.5%, the main pathological basis of the medium and small artery occlusion caused by avascular necrosis.

(3) mixed gangrene. About 20%. Microcirculation and small-artery occlusion exist two types of lesions, both extremities of the ischemic necrosis of dry, another foot, and (or) of the wet gangrene leg.

Classification of diabetic gangrene

0: No open lesions, clearly insufficient blood supply.

Grade Ⅰ: superficial ulcer. Blisters or other damage can be caused by, or arise spontaneously.

Grade Ⅱ: ulcer depth of tendons, ligaments, bones and joints.

Grade Ⅲ: deep ulcer infection and abscess with osteomyelitis and sinus formation.

Grade Ⅳ: There are toe and and (or) of the foot gangrene.

Ⅴ grade: All foot gangrene, which normally takes amputation.

The treatment of diabetic gangrene

(1) using diet control and drug treatment, strict control of diabetes, so that near-normal blood glucose levels, and to avoid the occurrence of low blood sugar.

(2) local surgical treatment. Gangrene, debridement and wrap it with antibacterial drugs and improving microcirculation.

(3) anticoagulation therapy. Dipyridamole, aspirin, Chinese medicine blood stasis agent.

(4) improvement of microcirculation. Anisodamine applications.

(5) antibiotic therapy. According to the results of bacterial culture and drug susceptibility tests use the appropriate antibiotics.

(6) other therapies. Given neurotrophic agent, are deficient in zinc, high-pressure oxygen therapy.

(7) cut-off toe, and (or) amputation.

(8) arterial reconstruction surgery.

The new method to prevention and treatment of diabetic and foot ulcers

The U.S. city of St. Louis, Washington University School of Medicine Professor of Physiotherapy, said foot Achilles tendon lengthening surgery can effectively solve the problem of diabetic foot ulcer relapse. Treatment of diabetic foot ulcers and the key issue is to reduce the recurrence of ulcers. If prolonged unhealed wound, the patient will have some or all of the risk of foot removed. J Bone Joint Surg published a study shows that use of Achilles tendon lengthening surgery can effectively reduce the recurrence rate of diabetic foot ulcers.

With diabetes, this is a big news. Diabetic foot ulcers are a major problem, minor inflammation may soon lead to foot ulcers. Foot diabetic neuropathy nerve damage caused by foot, so that diabetic patients can not become aware of the changes in the foot.

The U.S. city of St. Louis, Washington University School of Medicine Professor of Physiotherapy, said foot Achilles tendon lengthening surgery can effectively solve the problem of diabetic foot ulcer relapse. For ankle joint movement impairment, the method helps to walk in the patient's weight shift from foot to heel, to reduce the pressure on the front foot, reducing the risk of skin damage. Have a good heel fat pad, make the skin from stimulation, thereby reducing infection and ulcers.

The study, 64 patients were randomly assigned to two groups, one with the foot gypsum (foot cast) to protect the wound from oppression, to heal; the other group of gypsum increases with the foot Achilles tendon lengthening. Achilles tendon surgery would be extended to six weeks following a fixed can be cured.

Using only the foot in plaster group, 88% of patients with ulcer healing; while using foot gypsum plus surgery group, the ulcer healing rate was 100%.

The patient to resume walking within the first month of the peak period of recurrence of foot ulcers; 7 months after the surgery and foot ulcer recurrence rate of gypsum group was lower than 75% of foot gypsum; two years later, the low 53%.

The researchers pointed out that the Achilles tendon to extend to a certain extent, weakened the strength of calf muscles may cause unsteady gait, but can be enhanced through the gastrocnemius muscle exercises to improve. Patients with diabetic neuropathy, the treatment of chronic foot ulcers in order to reduce recurrence of hope.

Why is diabetes can result in skin necrosis

The reason why diabetes occurs lipoid progressive skin necrosis, caused mainly due to diabetic microangiopathy, sugar, protein deposition in the small vessel wall and gradually cause vascular occlusion, tissue necrosis. A rural women have often been in double-leg skin erythema, papules, and easy to ulcers, symptomatic treatment, have not ceased. After the hospital to conduct a comprehensive inspection, found to have diabetes, treatment, blood glucose control, the local symptomatic treatment, skin lesions subsided and so far no recurrence. The rural women with diabetes had skin disease - a progressive skin necrosis lipoidica.

The reason why diabetes occurs lipoid progressive skin necrosis, caused mainly due to diabetic microangiopathy, sugar, protein deposition in the small vessel wall and gradually cause vascular occlusion, tissue necrosis.

Lipoid progressive skin necrosis of the clinical manifestations are mainly two before the lower leg, thigh, ankle, foot appeared irregular round or oval scleroderma-like plaques, clear edge, the surface was smooth glaze-like, central depression was sulfur color, composition hard yellow plaque, the external was purple or light red. In the yellow area there are numerous telangiectasias and small dark spots, often scaling or crusting. About 1 / 3 of cases of erythema may occur on the basis of ulcers.

Lipoid progressive skin necrosis in patients with diabetes need for effective control of diabetes, but even if diabetes is controlled, the lesions can not be completely dissipated, only varying degrees of improvement. On the skin lesions are mainly taken by symptomatic treatment, while serving a number of blood circulation increases, improve microcirculation of the drugs, such as oral compound Danshen tablets and vitamin e. Need to be taken to avoid a calf injury and prolonged standing, the best qualified person raise both lower extremities, and pay attention to warm cold.

Diabetic friends foot was "wounded"

The clinical types of gangrene dry gangrene, wet gangrene, gangrene three kinds of hybrid. The characteristics of diabetic gangrene

Most of diabetic gangrene occurred in the elderly; male than female, male to female ratio is 3:2; course of the disease an average of about 10 years, parts of lower limb gangrene more common, accounting for 92.5%, upper limb rare, accounting for 7.5%; unilateral incidence of about 80%, bilateral disease at the same time about 20%; toe and gangrene of the foot at the same time more common, accounting for 77.5%; toe and lower leg gangrene while 5%, only 5% of leg gangrene; toe or finger disease accounted for 12.5%.

Clinical types of dry gangrene, wet gangrene, gangrene three kinds of hybrid.

(1) wet gangrene. Acral surface erosion of local soft tissue to form a shallow ulcer, followed by ulceration in-depth muscle, rather then the rotten broken tendon, bone damage, a large number of tissue necrosis, the formation of large abscess, and expel more secretions. This type of gangrene more common, accounting for 72.5%, mainly based on pathological microvascular basement membrane thickening due to microcirculation.

(2) Dry gangrene. Peripheral involvement acral necrosis, withered and black, lesion boundaries clear, to a certain stage of development will be handled on their own without falling. This type of gangrene or about 7.5%, the main pathological basis of the medium and small artery occlusion caused by avascular necrosis.

(3) mixed gangrene. About 20%. Microcirculation and small-artery occlusion exist two types of lesions, both extremities of the ischemic necrosis of dry, another foot, and (or) of the wet gangrene leg.

Classification of diabetic gangrene

0: No open lesions, clearly insufficient blood supply.

Grade Ⅰ: superficial ulcer. Blisters or other damage can be caused by, or arise spontaneously.

Grade Ⅱ: ulcer depth of tendons, ligaments, bones and joints.

Grade Ⅲ: deep ulcer infection and abscess with osteomyelitis and sinus formation.

Grade Ⅳ: There are toe and and (or) of the foot gangrene.

Ⅴ grade: All foot gangrene, which normally takes amputation.

The treatment of diabetic gangrene

(1) using diet control and drug treatment, strict control of diabetes, so that near-normal blood glucose levels, and to avoid the occurrence of low blood sugar.

(2) local surgical treatment. Gangrene, debridement and wrap it with antibacterial drugs and improving microcirculation.

(3) anticoagulation therapy. Dipyridamole, aspirin, Chinese medicine blood stasis agent.

(4) improvement of microcirculation. Anisodamine applications.

(5) antibiotic therapy. According to the results of bacterial culture and drug susceptibility tests use the appropriate antibiotics.

(6) other therapies. Given neurotrophic agent, are deficient in zinc, high-pressure oxygen therapy.

(7) cut-off toe, and (or) amputation.

(8) arterial reconstruction surgery.

Prevention is better than the treatment of diabetic foot

In China, population aging has become a trend, while the incidence of diabetes, often increases with age, so the number of elderly diabetic patients increased year by year. Many elderly people are aware that diabetes can cause heart, brain and blood vessel disease, kidney disease, arteriosclerosis, etc., and most of the diabetic patients with diabetic foot unfamiliar. Prevention: hard, but not simple

One, his mind taut 5 "Strings children"

Active prevention of diabetic foot from the occurrence of thought every one should pay attention to diabetes, the patients mind to tighten the 5 "Strings children":

The first is control of blood glucose. Mainly due to diabetes, diabetic foot caused by limb peripheral vascular, neuropathy due to secondary infection, while controlling blood sugar is a slow peripheral vascular, neuropathy occurred effective means. And that high blood sugar are also prone to infection, so strict control of blood sugar is a crucial step. Second, is due to peripheral neuropathy is an important factor in occurrence of diabetic foot, so proper nutrition and proper nerve medicine foot massage is also beneficial. Again is to protect the feet. Do not pass through tight shoes and socks, do not walk barefoot, but also to avoid a pedicure in order to reduce the risk of foot injury. Finally, active treatment athlete's foot. General patients have varying degrees of foot fungal infections, fungal infections are also one of the factors impaired wound healing.

In addition, the legs do the non-weight-bearing exercise (such as in bed to do flexion and extension movement of the legs) can be improved to some extent, lower limb circulation.

Second, be doubly cautious Mo hot feet

Before going to sleep at night, a pot of scalding hot water the effect of foot indeed recover from fatigue, but also a certain degree of health protection. However, not all of them very suitable for hot feet, especially with diabetes should be particularly careful. When the body's skin and experience a more high-temperature hot water when the local blood vessels would expand, blood flow will speed up, so the blood will take away excess heat, so that part will not hurt, but patients with diabetes would significantly decrease this feature . According to statistics, diabetic patients with diabetic foot gangrene caused by burns accounted for 14.5%, which is caused by accidental amputation diabetic foot disease an important reason. Patients with diabetes high blood sugar can cause the body due to peripheral neuropathy, micro-circulation and blood vessels. This change will inevitably occur in the foot. Peripheral neuropathy can cause the skin of the foot paresthesia, muscle atrophy, skin dryness and abnormal sweat secretion, so that the defensive function of the foot drop. Vascular lesions leading to microcirculation of blood supply to the foot to reduce foot nutritional deterioration of the organizations to restore capacity is low.

As a diabetic, you know: When you are hot foot on the one hand foot skin paresthesia could not be judged because of the high and low water temperature, so that I do not know enough to profit and avoid loss, on the other hand the skin microcirculation and vascular lesions of vascular can not be a normal expansion, reduction of blood supply to the skin also does not have enough blood to the heat away, so that gathering took place in local burn calories. Patients with severe burns when not in their own self-knowledge, so that further aggravate the burn. Diabetic foot risk of infection after burn significantly increased for patients great suffering and loss. So, is strongly recommended that patients with diabetes must be careful when washing one's feet. Diabetic patients feet, it is recommended not to exceed the surface temperature of the water temperature. Small to care about in life, sometimes you will be replacing a lot of body, time and economic losses. Patients with diabetes should be concerned about the details of life.

Third, elderly patients to lose weight

In China, population aging has become a trend, while the incidence of diabetes, often increases with age, so the number of elderly diabetic patients increased year by year. Many elderly people are aware that diabetes can cause heart, brain and blood vessel disease, kidney disease, arteriosclerosis, etc., and most of the diabetic patients with diabetic foot unfamiliar. While some people know, but do not understand the harm it. Because of this, also contributed to the prevalence of diabetic foot increase in the elderly.

Vigilance diabetic foot three-signal

Diabetes is peripheral neuropathy, micro-vascular disease, large vessel disease and poor health among the many factors that caused by complex interactions. Often due to infection in diabetic foot gangrene caused by foot and the next technology, known as "diabetic foot." Expressed as foot numbness, feeling numb, chills, pain. Once the disease because of its treatment of complex, difficult large, will face consequences such as amputation. Therefore, diabetic foot disease is a severe complication of diabetes, one of the most horrible. On the Diabetic Foot, the main reason for including the three surfaces,

The first is that patients with diabetes mellitus, chronic peripheral vascular complications, the peripheral vascular complications at an early stage due to the gradual stenosis of vascular lumen, arising from a series of clinical manifestations,: including the patient's lower limb numbness, pain, walking distance of more and more short, we are called intermittent claudication, or pain the patient is seated and immobile when the pain will appear, these are the patients with peripheral vascular diabetic complications;

The second aspect is the diabetic patients with chronic peripheral nerve complications, especially in diabetic patients the feeling of complications arising from loss of sensation or abnormal. For example the end of the limbs, especially the feeling of anomalies arising from the foot of the numbness, the feeling of walking seemed to tread, like cotton, or have pins and needles, and so a range of performance, these are patients with peripheral nerve complications of diabetes.

The third aspect is in the peripheral vascular and neurological complications on the basis, due to protection measures are not effective, due to wearing shoes, socks, clipping the nails, and so inappropriate, there has been broken the skin, followed by skin damage arising from a series of symptoms, eventually becoming ulcer healing, rapid deterioration, odor ... ... ... then this series of questions known as diabetic foot.

The so-called diabetic foot, especially in the early diabetic foot ulcers, mainly around the blood vessels and peripheral nerve complications basis.

Comprehensive analysis of the etiology of diabetic foot

Mainly due to diabetic foot disease caused by acral arteries and microvascular ischemia, hypoxia, organizations lose their vitality, coupled with neuropathy partial loss of consciousness, easy to damage, caused by infection. The disease pathology is mainly arteries and small arteries atherosclerosis, microcirculation disorder, affecting the absorption of nutrients and metabolic products of exclusion, resulting in acral ischemia, hypoxia, nutrition barriers, partial loss of vitality. Coupled with decreased resistance neuropathy, pain, temperature sense obstacles or disappeared, resulting in serious injury, ulcers, gangrene and infection, Shenzhe need amputation. In short, the disease was mainly due to arterial and microvascular disease caused by acral ischemia, hypoxia, organizations lose their vitality, coupled with neuropathy partial loss of consciousness, easy to damage, caused by infection.

1, arterial blood vessel blockage: Diabetes prone to atherosclerosis, so that the lumen of blood vessels arteries blocked, resulting in acral ischemia and hypoxia, diabetes gangrene. The reasons are: (1) hyperinsulinemia, in particular Type II diabetes, obesity, physical person, often tend to hyperinsulinemia. Cause fat metabolism disorders, induction and activation of fatty synthase, so that an increase in fat synthesis, very low density lipoprotein increased significantly, resulting in hyperlipoproteinemia and promote lipid deposition and smooth muscle cell proliferation, thereby causing atherosclerosis.

(2), platelet dysfunction, txa2 synthesis increased arterial intima damaged office pgl2 synthase is a lack of, pgl2 synthesis reduced enhanced platelet aggregation, blood vessels tend to spasm, contributed to the occurrence of arterial disease and partial blockage of blood vessels.

(3) endothelial cell injury due to genetic defects, easy to damage and necrosis. Hyperglycemia lead to damage and necrosis, arterial endothelial cell damage, the generation and destruction of clotting factors often out of balance, resulting in hardening of arteries and blocking blood vessels.

2, microvascular basement membrane thickening

Diabetic gangrene and microvascular lesions, basement membrane thickening are closely related. Microangiopathy in human weight-bearing area is particularly notable. As the capillary basement membrane thickening, causing fluid and protein leakage, resulting in swollen feet and prevent white blood cells into the cell, reducing the ability of local organizations, anti-infective, white energy increased fibrin activity reduced the formation of micro-thrombosis increase the local tissue ischemia necrosis, resulting in ulceration gangrene, wound long treatment.

Microvascular basement membrane thickening in diabetes, it is also accompanied by changes in the chemical structure of basement membrane thickening, sugar increased significantly, protein and fat reduced, with the exception of people with diabetes, age, duration, and the lack of insulin and other factors, the partial tissue hypoxia leading to the direct cause of diabetic microangiopathy, leading to local tissue hypoxia of the following factors:

(1) abnormal hemorheology and plasma fibrinogen in acute stress, beads globulin, a, acid glycoprotein was significantly higher and so on to promote the increased whole blood viscosity and erythrocyte aggregation, microvascular perfusion disorders.

(2) The mechanism of blood coagulation disorders, diabetes patients from Ⅷ, the first Ⅹ coagulation factors and fibrinogen were higher, fibrin activity to reduce the influence local tissue oxygen supply. Enhanced platelet aggregation, microcirculation blocked, increased local tissue hypoxia.

(3) an increase in glycated hemoglobin, glycated hemoglobin, or fast normal hemoglobin 7% of total hemoglobin, diabetes, glycosylated hemoglobin synthesis increased about 2-3 times the normal. Very difficult to break down, resulting in separation of oxygen reduction in tissue hypoxia.

(4) angiotensin-converting enzyme activity increased serum angiotensin-converting enzyme was significantly increased, microvascular disease, angiotensin-converting enzyme values higher, suggesting that diabetes in the blood vessels leading to tissue hypoxia spasticity.

3, diabetic neuropathy: diabetes mellitus complicated by vascular disease when associated with peripheral neuropathy and nerve of plant diseases, peripheral nerves leading to sensory and motor neurological disorders, muscle atrophy, skeletal deformities, pain, temperature sense weakened or disappeared, is trauma or self - organization to undermine the infected wound. Autonomic neuropathy leading to reduced sweating, dry skin vasomotor dysfunction, tissue ischemia and embrittlement infected necrosis. The presence of neuropathy the body of local organizations often exposed to danger, experienced trauma can lead to gangrene, diabetic neuropathy and diabetic vascular disease interaction, mutual influence of the gangrene infection increase the local tissue.

4, infection factors: a good diabetic patients uncontrolled host defense mechanism weakened response to the invasion of micro-organisms were inhibited at all stages, including the role and chemical toxins, phagocytic white blood cells, bactericidal effect of serum coherent factors and the role of cellular immunity , easy to infection, once infected, sicker. Due to neuropathy, acral sensory dysfunction, were infected with injuries. Diabetic microangiopathy to local tissue hypoxia is conducive to the growth of anaerobic bacteria to change the white blood oxygen dependent bactericidal effect, once infected, the ability to enhance platelet adhesion, fibrin activity increased, soluble fibrin activity reduced the formation of micro-thrombosis and increase the local tissue ischemic necrosis.

Diabetic gangrene is a traditional Chinese medicine, "Diabetes", "Pulse Bi", "anthrax" and other areas. Chinese medicine treatment of this disease has a long history and accumulated a lot of valuable experience in medicine that the pathogenesis of this disease is mainly Diabetes drag on, Qi and Yin Deficiency, meridians Stagnation, blood lines impeded, acral dystrophy, combined with hot and humid the next Note, heat sera stasis, made pulse weakness, anthrax. Elements found in modern medical research, diabetes, human memory, there is the unusual lack of zinc, zinc deficiency after wound healing is slow, prone to infection and organizations, liquefaction, is the main reason for diabetes, ulcers implemented. A large number of clinical studies have shown that zinc treatment can significantly speed up the wound healing. So we used the treatment of qi Yin, clearing away heat dampness, activating blood detoxification methods such as, dialectical therapy, family medicine recipe "sugar more side" with the elements of special hypoglycemic hypoglycemic agents plus zinc therapy received a significant effect, generally 30 days, significantly effective, basically cured within 90 days. Not only the wound can be healed, and physical body condition were significantly improved, showing a great advantage, particularly in wet lower extremity ulcer was unique, an average of 30 days can be healed by the medical profession of today's great concern.